A18029 Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New ACC/AHA Classification of Hypertension

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Objectives:The 2017 ACC/AHA guideline on hypertension proposed new diagnostic thresholds for clinic and ambulatory blood pressure (ABP). We derived outcome-driven thresholds for ABP based on the new classification of hypertension.Methods:We performed 24 h ABP monitoring in 10652 participants (mean age 58 years; 49% women) from 13 population cohorts. In multi-adjusted analyses, we determined ABP thresholds, resulting in 10-year cardiovascular risks similar to those associated with elevated blood pressure (120/80mmHg), stage1 (130/80mmHg), stage2 (140/90mmHg), and more severe (160/100mmHg) hypertension on office measurement.Results:Over 14.1 years (median), 1011 persons (rate per 1000 person years, 6.8) died of cardiovascular disease, and 1955 (13.9) fatal or non-fatal cardiovascular endpoints occurred. Systolic/diastolic thresholds for elevated ABP were 118.0/74.9mmHg for 24 h, 121.7/79.3mmHg for daytime, and 105.3/65.8mmHg for nighttime. Corresponding thresholds for stage1 and stage2 ABP hypertension were 123.4/74.9mmHg, 128.8/79.3mmHg, 111.7/65.8mmHg, and 128.9/80.5mmHg, 135.9/86.9mmHg, 118.2/72.3mmHg, respectively, and those for more severe hypertension were 139.8/86.1mmHg, 150.1/94.1mmHg, and 131.2/78.7mmHg. After rounding to the nearest 5mmHg, approximate thresholds for elevated ABP amounted to 120/75mmHg for 24 h, 120/80mmHg for daytime, and 105/65mmHg for nighttime. Rounded thresholds for stage1 and stage2 ABP hypertension were 125/75mmHg, 130/80mmHg, 110/65mmHg, and 130/80mmHg, 135/85mmHg, 120/70mmHg, respectively, and those for more severe hypertension were 140/85mmHg, 150/95mmHg, and 130/80mmHg.Conclusion:Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages1 and 2 of hypertension are similar to those proposed by the current ACC/AHA guideline.

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